1407880305 NPI number — KHALID MALIK MD

Table of content: KHALID MALIK MD (NPI 1407880305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407880305 NPI number — KHALID MALIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALIK
Provider First Name:
KHALID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407880305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 N JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75455-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-577-6000
Provider Business Mailing Address Fax Number:
903-577-6245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 TEXAS BLVD
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-794-6544
Provider Business Practice Location Address Fax Number:
903-794-6546
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  L7026 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8R0824 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 158167002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149856001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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